12/09/09 Teleconference - Inpatient Diabetes

Register for this free teleconference

Please fill out this brief form to register for the free teleconference on Joint Commission certification for inpatient diabetes programs.

You are free to have as many people listen as you wish. However, please register separately for each separate phone line that will be calling in.

December 9, 2009
Noon - 1pm Central Time
(1:00 Eastern Time, 11:00 Mountain Time, 10:00 Pacific Time)

For questions related to this form, e-mail deickemeyer@jointcommission.org

1. First Name

First Name

2. Last Name

Last Name

3. Title

Title

4. Company Name

Company Name

5. Street Address

Street Address

6. City

City

7. State

State

8. Zip Code

Zip Code

9. Telephone Number

Telephone Number

10. E-mail Address

E-mail Address

11. Is your organization currently certified by The Joint Commission for any Disease-Specific Care programs?

Is your organization currently certified by The Joint Commission for any Disease-Specific Care programs? Yes

Don't Know

12. If yes, please indicate your current certified program(s).

If yes, please indicate your current certified program(s).